Hospital Case Manager

Mediclinic Highveld; Louis Trichardt; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A leading healthcare provider in Louis Trichardt is seeking a Case Management Coordinator to manage patient stays and ensure compliance with procedures. The role requires a clinical qualification and at least 3 years of experience in a clinical environment. Responsibilities include effective communication with funders and adherence to clinical coding standards. This position offers an opportunity to contribute to healthcare efficiency in a supportive team environment.

Qualifications

• Minimum of 3 years in a clinical role.
• Experience in Theatre and/or ICU.
• Medical aid background desirable.

Responsibilities

• Manage patient stay to minimise financial risk.
• Ensure compliance to case management procedures.
• Communicate with funders as agreed.

Skills

Understanding of anatomy

Medical terminology

Clinical coding

Computer literacy

Patient Administration policies

Education

Clinical qualification

Registered Nurse / Professional Nurse

Qualified Paramedic

Tools

Microsoft Office

Hospital management systems

Job description

Overview

To coordinate the hospital case management process and facilitate the communication process between all role players by providing accurate and timeous clinical information to minimise the financial risk for the organisation.

Responsibilities

• Minimise financial risk by effectively managing patient stay
• Ensure compliance to case management procedures, contracts and legal aspects by utilising available resources and systems
• Ensure correct and timeous finalisation of cases to facilitate reimbursements from funders of claims
• Consistently and timeously communicate with Funders as contractually agreed through the relevant case management channels
• Ensure clinical coding standards are adhered to as per Level 3 coding guideline
• Lead and manage the people in the Case Management team (if applicable)

Required Education

• ESSENTIAL EDUCATION : Clinical qualification
• DESIRED EDUCATION : Registered Nurse / Professional Nurse or qualified Paramedic

Required Experience

• ESSENTIAL MINIMUM EXPERIENCE : Minimum of 3 years in a clinical role
• DESIRED EXPERIENCE : Experience in Theatre and or ICU; Medical aid background; Experience in private healthcare environment or experience as an ILS / ALS Paramedic

Required Skills and Knowledge

• Understanding of anatomy; physiology and medical terminology
• Funder Contracts; Medical aid requirements / narrations
• Scientific nursing principles and process
• Authorisation and motivation of Level of Care; Length of Stay; Clinical Coding, high-cost stock, Short Payments etc.
• Use of electronic systems (i.e. B2B or Funder portals) for the purposes of requesting authorisations, performing case management updates and for troubleshooting
• Computer literacy (Microsoft Office, hospital / practice management systems)
• Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.)
• Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.)
• Daily workflow; managing deviances; clinical coding; and case management processes
• Application of clinical codes and finalisation thereof